Prior studies have validated a novel index, designated as the cholesterol-HDL-glucose (CHG) index, which has emerged as a promising biological marker for abnormalities in lipid metabolism and insulin resistance. At present, however, there is an absence of data demonstrating its capacity to predict the risk of CMD. The objective of this study is to evaluate the comparative efficacy of the CHG index and the triglyceride-glucose (TyG) index in predicting cardiovascular metabolic disease (CMD) risk. This study was conducted on a cohort of 6471 participants from CHARLS. A binary logistic regression analysis was performed using R software, utilizing restricted cubic spline techniques to evaluate the dose–response relationship. The evaluation of predictive performance was carried out through the use of receiver operating characteristic curves. To quantify the improvements in predictive capability, two important indices were calculated: Net Reclassification Improvement and Integrated Discrimination Improvement were used to assess the enhancements in our predictive models. Finally, a sensitivity analysis was conducted. An increase in each unit of CHG and TyG was associated with a 83% and 46% rise in the risk of CMD, respectively. The occurrence of CMD in the highest quartile for the CHG index (OR = 1.69, 95% CI 1.42–2.00) increased by 69%, while the TyG index (OR = 1.61, 95% CI 1.36–1.92) exhibited an increase of 61%. A linear correlation was identified between the two indices and the risk of CMD. The predictive capabilities and incremental predictive value of both indices were found to be analogous. The CHG index exhibited a substantial linear positive correlation with CMD, demonstrating assessment capabilities for CMD risk that were analogous to those of the TyG index.

Aims: Mixed neuroendocrine‐non‐neuroendocrine neoplasms (MiNENs) represent a rare and heterogeneous subgroup of neoplasms that typically consist of a neuroendocrine (NE) component, most commonly neuroendocrine carcinoma (NEC), alongside a non‐neuroendocrine (non‐NE) component. They commonly occur in the digestive tract, and their prognosis is influenced by multiple factors. This article aimed to identify factors that affect the cancer‐specific survival (CSS) of MiNENs and develop an effective nomogram‐based online calculator to validate its effectiveness.Methods: The clinical, pathological, epidemiological, and survival data of patients with digestive tract MiNENs were collected from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2000 to 2020. Then, the dataset was divided into a training cohort and a validation cohort. The χ² test or Fisher's exact test was utilized to assess differences in demographic and clinicopathological characteristics between the two groups. Kaplan–Meier survival curves and log‐rank tests were employed to conduct survival analysis. Additionally, univariate and multivariate Cox regression analyses were performed to identify potential prognostic factors and develop nomograms and an online calculator for predicting CSS at 1, 3, and 5 years. Lastly, the predictive ability of the online calculator was subsequently compared with the sixth edition of the American Joint Committee on Cancer (AJCC) TNM staging system using the Harrell concordance index (C‐index), the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).Results: A total of 330 patients were randomly assigned to two groups, namely, the training cohort (n = 231) and the validation cohort (n = 99). The log‐rank test revealed a significant association between the lower cumulative survival and age ≥ 65 years, poor tumor grade, lack of surgical treatment, TNM stages III and IV, and distant metastasis. In the training cohort, a nomogram incorporating grade, surgery, TNM stage, and tumor metastasis was developed, which demonstrated favorable calibration and discriminatory capabilities. Compared to TNM staging, the nomogram exhibited satisfactory performance in predicting 1‐year, 3‐year, and 5‐year CSS rates. The C‐index value was 0.787 in the training cohort and 0.738 in the validation cohort, respectively. In the training cohort, the nomogram achieved an AUC of 85.81%, 85.86%, and 87.32% for 1‐year CSS, 3‐year CSS, and 5‐year CSS, respectively. In contrast, these AUC values were 78.46%, 81.50%, and 83.88% in the validation cohort, respectively.Conclusions: The developed online calculator offers a novel approach to predicting the prognosis of patients with digestive tract MiNENs. Indeed, it can accurately predict the CSS of these patients over 1, 3, and 5 years, thereby assisting in enhancing prognosis and formulating appropriate treatment strategies.

Previous observational studies have suggested a protective effect of Helicobacter pylori (HP) infection against the incidence of esophageal adenocarcinoma(EAC). To further validate this perspective at the genetic level, we employed Mendelian randomization (MR) to analyze the correlation between HP infection-related serological antibodies and EAC in the European population. This study employed a two-sample MR analysis method, utilizing GWAS data on seven serological antibodies related to HP infection selected from European populations as instrumental variables. The outcome data comprised GWAS data from 16,790 cases of EAC. Three analytical techniques were employed: inverse variance weighting, Egger -MR, and weighted median method. Additionally, Cochran's Q test, Egger -MR intercept test, MR-Presso method, and leave-one-out analysis were utilized for sensitivity analyses. The results of analysis indicated no clear relationship between the seven serological antibodies related to HP infection and the incidence of EAC in European populations(all p > 0.05). The secondary outcomes further validated the previously mentioned results (p > 0.05), with analyses of heterogeneity (p > 0.05) and pleiotropy (p > 0.05) confirming the robustness of the MR results. No significant association was detected between various serological antibodies related to HP infection and the incidence of EAC in the European population. This may, to some extent, negated the protective role of HP infection against EAC.

Endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFTR) are efficacious and reliable methods for managing gastrointestinal subepithelial tumors [1] [2] [3]. Some traction methods are often used to expose subepithelial tumors [3]. However, traditional traction methods may be inadequate for full exposure and complete excavation [4] [5]. To address this issue, we have developed an internal and external bidirectional traction method that has been successfully utilized in ESE ([Video 1]). A 40-year-old man with a huge subepithelial tumor located in the fornix of the gastric fundus near the cardia was referred for ESE treatment ([Fig. 1] a). Due to the specific location and the limited angle of the endoscope, it was difficult to get close to the tumor. First, a clip with a rubber band was attached to the mucosa on the anal side of the tumor. Then the second clip picked up the rubber band and fixed it to the greater curvature mucosa opposite the gastric fundus ([Fig. 1] b). After transverse incision of the mucosa, the tumor was clearly exposed ([Fig. 1] c). We dissected the outer edge of the tumor and found that it was difficult to expose the boundary. The third clip with dental floss was fixed on the oral side of the incised mucosa ([Fig. 1] d). By pulling the dental floss and using air control, the boundary of the tumor was clearly exposed. Under lifting force of the internal and external bidirectional traction, the tumor was excavated quickly and completely ([Fig. 1] e). Since the surgical wound was well presented using this traction method, we performed sufficient hemostasis on the entire wound ([Fig. 1] f). This method helps to expose the tumor quickly during incision of the mucosa, meanwhile ensuring dissection of the tumor with the complete capsule. It does not require special instruments and may be a suitable method for the ESE and EFTR in some special sites. Endoscopy_UCTN_Code_TTT_1AO_2AG Article published online: 11 April 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany